I’ve spent the last 15 years in the tech startup community including several early stage ventures with successful exits in the healthcare space. I'm also a Top Writer on Quora (2012 and 2013) for several healthcare specific topics. I'm likely to include film references and quotes as in "All of life's riddles are answered in the movies." Twitter handle is: @danmunro

The author is a Forbes contributor. The opinions expressed are those of the writer.

Healthcare's Medical Gluttony

Seems to me we always have a few big breaking healthcare stories early in the year. I remember last year when Mary Meeker released her stunning report – USA, Inc. For the first time, it gave us a detailed view into the health of our country – as if it were a Corporation using balance sheet accounting. That report is truly outstanding. If you haven’t read it – I can’t recommend it highly enough. In some ways I think it’s “table stakes” for any intelligent discussion around the health (and healthcare) of our Country. In that report are two charts that graphically illustrate the size of our healthcare spending (as reported through 2009) – and then the results of our healthcare system. This was the first one:

From Mary Meeker's Report - USA, Inc.

Lot’s of takeaways from this. Including the sheer size ($2.5 trillion in 2009) – and at least one financial opinion that we don’t have a debt problem in this country – we have a healthcare problem. In this graph, Mary Meeker’s focus was more on the hyper-growth of Medicare/Medicaid – which basically went from 0% to 35% in about 45 years. It doesn’t take a proverbial Village to see this chart and that statistic as unsustainable. The companion chart was one that compared our healthcare results (as measured by Life Expectancy) to other countries using per capita cost per year. This too was eye-popping:

OECD Data for 2009

For those of us that have been tracking this over the years – no real surprises – these numbers don’t just arrive in a year. It takes a sustained effort to deliver this kind of appalling value – for this kind of money. Shocking? Clearly. Surprising? Not so much. No, the real, perhaps only question is – what’s causing this – and how do we really stop it? Of course this debate has raged for years – and is still ongoing. Lots of good politicking, teeth gnashing, jaw boning, turf protecting and food fighting. Hey – there’s lots of blame to pass around.

Finally, in March of 2010 – President Obama signed into law the Patient Protection and Affordable Care Act – or PPACA for short. We were told this was THE fix – or the best we could reasonably get. We were told that healthcare insurance was to blame. Profits were obscene and they had been denying coverage for “pre-existing” conditions. Insurance companies were inefficient accounting bureaucrats – that delivered no value. We were told that our system of “fee-for-service” was a system of sheer volume over value. We were told that 50 million uninsured was a major cause of higher insurance costs for everyone. All true – and all partially to blame. But were any of those really core, systemic issues – or were they, are they conveniently around the edges?

Dr. Otis Webb Brawley - CMO of the American Cancer Society

Now, for the first time, a leading healthcare clinician – the Chief Medical Officer of the American Cancer Society – Dr. Otis Webb Brawley is breaking ranks – literally and figuratively. His new book is squarely aimed at the Hippocratic oath and aptly titled – How We Do Harm: A Doctor Breaks Ranks About Being Sick In America. I haven’t read it (yet) – but even the Editorial Reviews are noteworthy:

“My friend and colleague Otis Brawley has written a raw and honest portrayal of our health care system. There are certain to be special interest organizations and medical groups that take issue with Dr.Brawley’s conclusions, but few can argue with the scientific rigor he has demonstrated in writing this book. Otis is the go- to oncologist I send so many patients to see, because he is not only a great doctor, but also a compassionate man. As we discuss the transformation of health care in this country, put Dr. Brawley’s book at the top of your list.” Sanjay Gupta, Associate Chief of Neurosurgery Grady Memorial Hospital, Chief Medical Correspondent, CNN

“Otis Brawley is one of America’s truly outstanding physician scientists. In How We Do Harm, he challenges all of us– physicians, patients, and communities– to recommit ourselves to the pledge to ‘do no harm.’” David Satcher, Former Surgeon General of the United States, Director, Satcher Health Leadership Institute, Morehouse School of Medicine

“Sweeping, honest and brave . . . How We Do Harm dazzles with a wealth of scientific insight, but its genius lies in the author’s recounting of individual patient stories that illuminate the dark underbelly of medicine’s missteps. Brawley does not shrink from revealing medicine’s warts, but this book offers much more. It is a triumph of humanity and clarity in which oncology becomes a Rorschach for the practice of American medicine. You will finish this arresting book reluctantly, with a new appreciation of what American medicine could be.” Harriet A .Washington, author of Deadly Monopolies: The Shocking Corporate Takeover of Life Itself and the Consequences for Your Health and Our Medical Future and Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

“There is often selective reading of the science, especially by those trained in a specialty wanting to advocate for it.”

“Medical gluttony, the inappropriate use and overuse of medical treatment, is not just adding unnecessary cost to health care. It can actually be harmful to the individual.”

“Health care providers and the public often overlook the emotional and financial conflicts of interest of health care professionals.”

The CNN article also recounted the story of a woman, Helen, who was diagnosed with early stage breast cancer. As was fairly common in the early 1990′s – surgery was followed by high doses of chemotherapy – and a bone marrow transplant. Quoting Dr. Brawley:

“The therapy Helen received was expensive and commonly given to women with breast cancer in the early 1990s. During this time, numerous women sued insurance companies who did not want to pay for the therapy and nearly a dozen states passed laws saying insurance companies had to pay for it.”

“There was one really good reason why the health insurers did not want to pay for high dose chemotherapy and bone marrow transplant for breast cancer: No study had ever been done to prove it beneficial.“

“Even without evidence, some patients and their doctors had faith that it worked. The procedure was common because some doctors taught that the transplant was beneficial to patients. Truth be told, it was very beneficial to the doctors and hospitals offering it.”

“By 1999, well after Helen had recovered, three well-designed clinical trials were completed. They showed that bone marrow transplant and high dose chemotherapy, a treatment now common for nearly a decade and a half, was not better than the standard therapy and there were indications it was more harmful.”

Again, I haven’t read the book – it’s just releasing today – but all of this does suggest at least one more very large and systemic failing in our healthcare system. It also adds a new clinical term that I had not heard before. Medical gluttony. Simply put, the healthcare system we have rewards expensive specialty care over primary preventative care. In order to reduce expensive specialty care – you have to add primary preventative care. I can’t help but agree with Dr. Brawley’s final prescription: ”The cold hard reality is America does not need to reform health care, we need to transform health care.”

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Of course Dan Munro realizes that the first bit of cherry picked info was before Medicare existed. How else was he to make a chart with big impressive looking numbers? Notice how the charts also don’t adjust for inflation or population growth.

It may have been a typo in Mary Meeker’s original report – I can’t tell. She references 1965 in the header of the graph (which I didn’t include) – but then 1960 in the body of the graph (twice). Either way – 1960 or 1965 – Medicare was $0 – so the conclusion wouldn’t change much – if any.

If/when you read the report – you’ll see both the context – and how trivial that mistake truly is. It’s only 266 pages.

We have no hope! “Healthcare” has achieved the same status as “Climate Change” — it stopped being science and became politics. Al Gore used his Polar Bears to revive a personal life after a failed political career — and silenced every scientist’s credibility.

If our President gets reelected, the “Affordability” Act will become the fiscal and personal disaster 2,000 pages of “don’t read it” will create. And experienced, intelligent voices like Dr. Brawley will be confined to a few readers because to one side or the other he is a mortal enemy to be silenced as only a government with absolute power can. Wish our government was as good at keeping us healthy.

Lots of people blame the insurance companies and hospital administrators. I say the doctors share equal blame. They have the real power in the system. If the AMA membership really wanted health care in America to change, it would very quickly. As long as the doctors place their golf memberships ahead of their patients’ well-being, we will have lousy, expensive health care in this country. Part of the solution might be to allow the immigration to the U.S. of more foreign doctors, required to practice according to AMA medical and Medicare cost guidelines. The AMA has a monopoly, so of course health care is expensive. More doctors = more competition = less expensive, higher quality health care.

Hooray! Someone has it right. If we can import doctors the cost will surely drop. The other solution, also, is to make Employer Provided Health Insurance taxable income to the extent that the consumers pays most the cost for basic healthcare out-of-pocket and the “insurance” only kicks in extraordinary circumstances.

Why are we vilifying doctors for making money saving lives and improving our health? We are quick to blame them (as evidenced by the excessive malpractice suits), but the greatest portion of health care costs stem from out-patient care. This means 1-day doctor visits/hospital stays, non-invasive procedures, etc make up the greatest portion of this 2.5 trillion dollar bill. There is no single culprit for the astronomical spending. The reality is that health care, as a system, is not at all conductive to cost-effectiveness considering that it is a for-profit system. On the other hand, a large-scale overhaul is impossible given the current political environment. Take your pick, citizens of America.

Whats causing this ? Whats driving this health care fiasco ? We are creating our own health care woes. Its a combination of things. For instance, inspite of what is known and proven about smoking people still do it. What does smoking do ? It destroys your health in a number of ways. Heart and lung issues mostly but it is a drug and there are problems with this also.

At least 50% of people in the US are over weight, 35% percent of those are considered obese. Obesity brings on all kinds of medical problems, diabetes, joint issues, heart problems etc. I have a close friend who is 50 LBs over weight. He has dibilitating back problems. Instead of losing the 50 Lbs that are the root of his problem he thinks an operation will solve his problem. He’s doing it to himself. You don’t walk around with 50 extra pounds on your body and not expect to have trouble in some way.

Drug abuse and all the wonderful problems that brings. I could go on and on.

In general we are not taking care of ourselves. Common sense does not prevail its the exception. You don’t do things to harm your body in the name of pleasure. Eating isn’t sport. Ask Paula Deene. You eat because you need to. You eat what you need.

You don’t bring foreign matter like smoke into your lungs. Not a good idea but inspite of what is known and readily available information on the subject people still do it. The tobacco companies make a product they know and we all know harms people. But they still make it because they say if we don’t somebody else will and we don’t care if people destroy their health with our product as long as we’re making money. Amazing but thats the reality of it. If no one smoked the tobacco industry would fold. Continue to smoke and they’ll supply you with all the tobacco you need to do your self in.

Not to mention our health care system is being over burdened with people who have no health insurance. These things are driving health care costs through the roof and putting it out of reach for many.

Think about it. Our unhealthy ways are a large part of our economy. It employs a lot of people. If everyone took care of them selves the health care labor force wouldn’t be nearly as big as it is today. Sure its employing a lot of people who need work but for the wrong reasons. In other words lets not build an economic machine on a bad foundation.

This article claims: “We were told this was THE fix – or the best we could reasonably get.” Actually what we got wasn’t even close to the proposed fix, we got the best that could be managed with an obstructionist Congress in the pocket of Big Pharma. If the career politicians and the lobbyists got out of the way, we could have a MUCH better solution to the out of control healthcare situation in America. But too many 1%ers would loose too much in profits if we actually got the costs under control.